Multiple Sclerosis and Mental Health: 3 Common Challenges

Multiple sclerosis (MS) affects everyone differently. If you or your loved one has MS, you are probably familiar with symptoms such as difficulty walking, fatigue, and numbness or tingling. These and other physical symptoms can be severe and limiting. However, emotional changes and mental health challenges can be just as (if not more) disabling.

1. Depression

Depression can occur in up to 50 percent of MS patients and is three times more common than in the general population. Up to 40 percent of support partners, such as caregivers and spouses, may also experience depression at some point in life. Household role changes and financial concerns, as well as depression and cognitive symptoms in the person with MS, are all factors that may contribute to caregiver distress.

Depression was identified in connection with multiple sclerosis back in the 1870s by the French neurologist Jean-Martin Charcot. However, it hasn’t been studied and seriously addressed by physicians until recent decades. Despite a better understanding of depression’s impact, it is still frequently underdiagnosed and undertreated in people with MS.

Depression in MS: a symptom or a reaction?

“It is easy to assume that people with a chronic illness like MS will inevitably become depressed,” says Beier. This incorrect assumption relies on the idea that depression is a reaction to MS. While this is possible, recent research has discovered that depression may also be a symptom.

“For persons with relapsing-remitting MS, early in the disease, depression appears to be linked to inflammatory processes. Later, in the secondary-progressive phase, unhelpful thoughts, such as feelings of guilt, worthlessness or hopelessness are more frequent. So the depression in this case is thought to be more reactive — linked to frustrations with lifestyle changes or loss of function,” explains Beier.

How to Address MS-Related Depression

Depression, together with anxiety, may worsen thoughts of suicide and shouldn’t be left untreated. In most cases, it can be effectively managed with a combination of antidepressants and cognitive behavioral therapy. This type of therapy focuses on identifying and shifting thoughts, beliefs and behaviors that may contribute to emotional distress.

2. Anxiety

Approximately half of people who have MS and depression also experience anxiety. But anxiety can also occur independently without depression. Anxiety disorders are three times more common in MS than in the general population. Anxiety has been linked to decreased social interaction, increased risk of excessive alcohol use, increased levels of pain and may even impact cognitive skills such as how fast your brain processes information.

Causes of MS-Related Anxiety

When it comes to living with multiple sclerosis, anxiety often stems from the uncertainty over what the next day will bring. In relapsing-remitting MS, the flare-ups can occur unexpectedly. “You never know if there is going to be an exacerbation, how severe the symptoms will be if an exacerbation occurs or if MS symptoms will progress over time,” says Beier. It can be difficult not to worry, especially if you have many responsibilities around caring for your health, family or children and work.

The Danger of Anxiety: Avoidance Behaviors

If you’ve ever experienced anxiety, you know it can make daily life difficult. One way some people deal with anxiety is by avoiding its source. When you get anxious about getting dizzy while driving, your instinct may be to avoid getting in the car. Or if you are afraid of having a bowel accident in public, not leaving the house may seem like a good solution. These avoidance behaviors could make you skip a doctor’s appointment, reduce your time with friends or stop you from doing what you enjoy.

“People who have both MS and anxiety are more likely to have suicidal thoughts,” adds Beier. Although data varies, it is estimated that up to 15 percent of people with MS die of suicide. If you notice avoidance behaviors, or anxiety that is impacting daily life, it’s important to start a conversation with a doctor.

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